Hacking Recovery: what makes 12 Step Programs work, and how to make them work better (part 1)

Many sexual strugglers find help in 12 Step Programs – such as Sex Addicts Anonymous and Sexaholics Anonymous – which adapt the Alcoholics Anonymous (AA) program to focus on sexual addiction. To be sure, 12 Step groups are not universally praised. Many people fault them for being “too religious” or “too Christian,” while at the same time many Christians reject them because they are “not Christian” enough. I have written other articles about the religion/Christianity issue, and today I want to focus instead on a different question:

Why do 12-Step programs work? What is it about the way these groups function that makes them effective? If we can figure out why AA and the 12 Steps work (what the “active ingredients” are) we might be able to improve them, reconfigure them in ways that work for other people.

Some months ago Wired magazine ran an article – written by Brendan Koerner – that addressed this topic. It’s very interesting reading, but be warned: if you are a 12 Step lover, the article will probably make you mad. Koerner cites a number of studies over the years trying to determine how effective AA is.

The bottom line: studies do show that AA is effective, but not universally so. It works for some people and not for others, and people disagree violently about why this is so. The statistics show a fairly consistent pattern: 12 Step programs on the whole work better than pretty much anything else. People who go to AA tend to find sobriety at higher rates than those who try other programs/approaches.

“There’s no doubt that when AA works, it can be transformative. But what aspect of the program deserves most of the credit? Is it the act of surrendering to a higher power? The making of amends to people a drinker has wronged? The simple admission that you have a problem? Stunningly, even the most highly regarded AA experts have no idea … The problem is so vexing, in fact, that addiction professionals have largely accepted that AA itself will always be an enigma.”

But research in other fields — especially behavior change and neurology — offers some insight into what exactly is happening in those church basements where 12 step groups meet. The article goes on to list several factors that contribute to AA’s success. I’ll list them here, along with some of my own thoughts:

1. The power of the group. Gathering together with people who share our struggle lifts spirits, creates bonds that provide support, and gives acceptance that undoes the damage of shame. Each of these factors is extremely important for recovery to work. Especially in early recovery – and especially with sex – overcoming shame is a key challenge. Shame fuels hopelessness and contributes to isolation. By getting people to open up with others, the power of secrecy is greatly diminished.

2. Service – particularly sponsorship – gives people new meaning and purpose. As Koerner says, numerous studies show that members who get involved in activities like sponsorship are more likely to stay sober than those who simply attend meetings. It’s hard to interpret the statistics on this one. People who are engaging in service are more likely to stay sober than those who aren’t … well could it be that it’s simply a matter of commitment? In other words, people who are fully engaging in the program are going to be doing service, because that’s part of the program.

3. The friend effect. A 2007 study of a Boston-area community found that person’s odds of being obese increase 71% if they have a same-sex friend who is obese. A paper published in the Annals of Internal Medicine concluded that a person is 50% more likely be to a heavy drinker if a friend or relative is also a heavy drinker. Wealth speakers have reported that you can determine a person’s income by determining the average income of their 5 closest friends. By associating with people who are in recovery, our own recovery stays strong.

4. Personal reflection and confession in the steps – especially in steps one, four, and five – help establish new levels of self-awareness and overcome shame. This process may also rewire the brain. Specifically, scientists believe that it may reinvigorate the pre-fontal cortex, which gets damaged in addiction. As dependence on an addictive substance or behavior grows, the regulation of the prefrontal cortex gets lax. Koerner puts it this way:

“The loss of synaptic plasticity is thought to be a major reason why more than 90 percent of recovering alcoholics relapse at some point. The newly sober are constantly bombarded with sensory cues that their brain associates with their pleasurable habit. Because the synapses in their prefrontal cortex are still damaged, they have a tough time resisting the urges created by these triggers. Any small reminder of their former life—the scent of stale beer, the clink of toasting glasses—is enough to knock them off the wagon.”

“AA, it seems, helps neutralize the power of these sensory cues by whipping the prefrontal cortex back into shape. Publicly revealing one’s deepest flaws and hearing others do likewise forces a person to confront the terrible consequences of their alcoholism—something that is very difficult to do all alone. This, in turn, prods the impaired prefrontal cortex into resuming its regulatory mission.”

5. The process of making amends can help alleviate feelings of guilt and may limit the stresses that trigger relapse. The article doesn’t address this topic in much detail, but it’s a good point, and worth reflecting on. As stated in point 1 above, whatever we can do to alleviate shame, the higher the chances are of sustained recovery. Confessing and making amends can make a profound difference in peoples’ sense of self, freeing them up to envision a new life for themselves.

So there you have the list that Koerner cites in the article. I feel the list is incomplete, so I’m adding the “Conspicuously Absent from Koerner’s Article Critical Success Factor”:

6. Renewed faith (or renewed spiritual connection). From my perspective, the spiritual aspect of the 12 Step program is given very little attention in this article. This is unfortunate, and for anyone involved in a 12 Step program, it is likely a surprising oversight. Many people cite the spiritual part of the 12 Step program as the cornerstone of its recovery message.

Part of the problem with trying to talk about matters of faith in an article like this is that spiritual things are really hard to measure, and the whole topic of how faith can help people recover doesn’t fit very well with the data-nerd ethos of a magazine like Wired. The author also points out that, while the spiritual aspect is cited by some as a reason for the success of the program, it also pushes other people away.

Even so, I wanted to add it here to this list, because it seems like an essential part of the recovery process for the people I have observed and worked with.

Coming Soon: In part 2 of this article, I’ll address the issue that flows out of this list of “critical success factors.” If these are the things that make 12 Steps Work, what can we do to make them work better? How can we improve 12 Step groups? Stay tuned.

(Click here to read part 2)

Meanwhile, I’d love to hear  your thoughts about the success factors I mention here in this post. Thanks!


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